The authors, on their experience and results of Italian Report on hepatic trauma, describe how to perform the simply and correctly packing and depacking.

In our series we observed 2515 cases: 989 (39.4%) patients was underwent at NOM (Non Operative Management) e 1525 (60.6%) at OM (Operative Management). In 173 cases was performed the packing for the impossibility to control the hemorrhage and for haemodynamic instability. The mortality rate was 21.4% (37 deaths), in 20 cases due at the hemorrhage. The most frequent complications was hemorrhage (12.7 %), abscess and necrosis (7.5 %), MOF (Multi Organ Failure) 3.5 % and DIC (Disseminated Intravascular Coagulation) 2.3 %.

After depacking, the most frequent complications are necrosis( 9 cases ), hemorrhage ( 5 cases ) and sepsis ( 3 cases ). The mortality rate was 4% ( 7 patients , 4 for hemorrhage and 3 for sepsis).

The packing require, the manual compression of the liver toward the top; later to position laparotomic dresses directly on the liver or with interposition of steri-drape on the back-lower side to push it forward against diaphragm and the abdominal wall. During depacking, performed after 24-48 hours, to start slowly at the removal of the dresses soaked plentifully with hot solution; to proceed hurriedly make probable the re-bleeding. Often the necrosectomy it's necessary; the wide resection or a serious bleeding are infrequently.

During surgical treatment for hepatic trauma, the packing is necessary when is impossible to control the bleeding. This procedure is the ideal "bridge" solution to stabilize the patient's conditions and to allow the final treatment with haemodynamic stability.